胃大部切除术后胃镜检查102例分析

目的 探讨胃大部切除术后残胃病变的发生情况。方法 102例胃大部切除术后进行胃镜与病理检查。结果 残胃炎50例，占49％；吻合口炎20例，占19．6％；吻合口溃疡7例占6．9％；残胃复发性肿瘤10例，占9．8％；残胃癌5例，占4．9％；吻合口狭窄10例占9．8％；以残胃炎与吻合口炎为多见，占68．3％。结论 胃大部切除术后均有各种不同程度的病变，必须及时作内镜检查。     

76例老年急诊胃大部切除临床分析

７６例老年急诊胃大部切除临床分析吴坚颜怀远南京市第三医院外一科（２１０００８）许桂林南京市中医院外科（２１０００１）胃十二指肠溃疡急性穿孔是消化道溃疡病常见的严重并发症，占溃疡病的１３．３％，死亡率高。目前主要处理方法是穿孔修补、一期胃大部切除、胃后...     

366例残胃内镜及病理分析

残胃癌是指胃良性疾病行胃大部切除术后 5年以上或胃癌根治术后 10年以上残胃内发生的癌 [1]。我们回顾分析 1994年至 1998年间 366例残胃内镜下的观察，比较其组织病理变化，并探讨残胃癌肿的发生特点。 　　一、资料和方法 　　1．一般资料：本组残胃 366例，男 322例，女 44例。年龄平均（ 54.5± 13.7）岁。其中行 Billroth I式（ B I式）共 125例，原发病胃癌 64例，良性病变 61例； BillrothII式（ B II式）共 138例，原发病胃癌 51例，良性病变 87例；近端胃倒次全切除手术 99例，原发病食管下段癌 4例，胃底癌 8例，贲门癌 87例…     

胃、十二指肠病变内镜与舌象观察(附600例报告)

舌诊是中医诊断疾病的重要手段之一。作者自1985～1995年对600例胃、十二指肠病变患者进行胃镜检查及音诊，并分析胃粘腊病变与舌象的关系。现报告如下。回临床资料1．l一般资料：本组600例中，男390例，女210例，年龄20～78岁；病程在3个月～1年者94例，2～10年者300例，10年以上者206例。诊断为慢性浅表性胃炎329例（占55％），慢性萎缩性胃炎41例（占7％），溃疡病（静止期）55例（占9％），溃疡病及十二指肠炎92例（占15％），复合性十二指肠炎68例（占11％），胃癌15例（占3％）。1．2观察方法：于当天上午进行胃镜检查前，在自然光线…     

全胃切除、改良Double tract代胃术治疗老年胃癌68例疗效观察

对68例75岁以上胃癌患者，在全麻下行全胃切除，改良Double tract代胃术，其中根治性切除49例，姑息性切除19例。术后并发症发生率22．1％（15／68），无术中死亡，术后死亡2例（脑梗死1例，肺动脉栓塞1例）。姑息性切除的19例患者17例获随访，1、2、3a总生存率分别为31．2％、5．9％和0。根治性切除的49例患者中45例获随访，1、2、3a总生存率分别为66．7％、42．2％和23．8％。认为胃癌患者行全胃切除，改良Double tract代胃术安全、有效。     

胃、十二指肠

541901 胃大部切除术后内窥镜观察远期疗效分析(附103例报告)/王连舫//实用外科杂志。-5(8).-421～2 报告胃大部切除1300例中随机抽样103例,使用GIF-K纤维胃镜检查进行远期疗效分析。103例均因溃疡病行胃大部分切除,其中十二指肠球部溃疡72例,胃溃疡31例。行B-Ⅰ吻合者6例;B-Ⅱ吻合者97例。术后时间5～19年。术后有明显症状者37例,以吻合口溃疡及吻合口残线合并溃疡或重度残胃炎患者临床症状多见。103例溃疡病患者手术前,纤维胃镜检查合并胃炎改变者只有38例。     

内镜检查术后胃162例

目的探讨术后胃的并发症及镜下特点．方法162例中，男129例，女33例，年龄18岁～74岁，均行胃大部切除术：毕Ⅰ式26例，毕Ⅱ式136例内镜诊断：残胃及吻合口炎116例（残线炎10例）、残胃及吻合口溃疡17例、双筒状吻合口5例、残胃癌及残胃复发癌23例、吻合口及输出拌狭窄5例、未见异常1例结果本组报道残胃癌的发病率3．9％（3／77），平均发病时间为术后14．2a，好发于残胃小弯及吻合口．残胃复发癌的发病率为25．53％（20／85），发生在术后2a内12例（60％），5a内18例（90％）．5a以上2例（10％），好发在吻合口、残胃小弯及胃底．残胃及吻合口炎镜下呈“牛肉红色”，易引起腹痛、腹胀．吻合口溃疡是术后胃最严重的并发症，其镜下形态与胃和十二指肠溃疡相似，但临床症状较轻．结论由于输入、输出拌过于弯曲致双筒状吻合口形成，它易导致吻合口溃疡；而近来认为是由于吻合口溃疡愈合，才导致其形成．     

残胃炎和吻合口炎

应用纤维胃镜检查胃大部切除术后288例.其中,以残胃炎和吻合口炎为主,共230例(79.9%),吻合口溃疡20例(6.9%),残胃癌3例和胃癌术后复发癌35例(13.2%).作者讨论了残胃炎及/和吻合口炎的诊断、发病因素以及和吻合口溃疡、残胃癌的关系.并指出对胆汁和十二指肠内容物反流、手术方式的选择及术后胃胃镜的随访均需予以重视.     

胃大部切除胃空肠RouX-Y活瓣吻合36例

本文作者通过改良胃大部切除胃肠道重建术式-胃空肠Roux-Y活瓣吻合.应用于胃大部切除36例,临床效果良好,未见胆汁反流性胃炎,倾倒综合征,输入、出襻综合征,梗阻等并发症.是一种符合生理功能,安全、理想的胃肠道重建的术式.     

胃大部切除胃空肠Roux-Y吻合21例

我们1992－03／1995－05采用胃大部切除鲁空肠R0ux．Y吻合术治疗胃十二指肠溃疡及胃癌21例，术后通过随访观察，发现该术式术后胃肠功能恢复快；可以减少十二指肠残端假的发生；保证残胃在无张力下的吻合；避免碱性十二指肠液的反流，预防残胃癌的发生等方面均有积极意义，疗效满意，报道如下：回对象和方法回．回对象本组男14例，女7例，年龄30岁～62岁，平均43岁，病程2a～20a，平均5．5a十二指肠球部溃疡11例，鲁十二指肠复合溃疡3例，胃溃疡2例，胃癌5例回．Z方法术中根据需要，先做胃大部切除，胃癌则做根治性切除，闭合残胃小弯侧及…     

Campylobacter pylori in Japan: bacteriological feature and prevalence in healthy subjects and patients with gastroduodenal disorders

The presence of Campylobacter pylori was investigated in biopsy specimens obtained during gastrofiberscopy from 103 consecutive patients prospectively. Patients included 25 with gastric ulcer, 4 with duodenal ulcer, 5 with coexisting gastroduodenal ulcer, 31 with gastroduodenal ulcer with gastritis, 27 with gastritis, 3 with gastric polyps and 8 with gastric cancer. Results were compared with 20 healthy control subjects who were endoscopically normal. Two specimens each were taken from 3 sites in the stomach. One part was used for a histological study to examine the presence of the organisms. The other part was cultured using Skirrow's agar microaerophilically. Conventional microflora and C. pylori were examined in gastric contents of some cases. Bacteriological features of isolated strains of C. pylori were identical to the NCTC strain. C. pylori was the most dominant organism in gastric contents at any pH level. Detection rates of C. pylori by bacteriological culture were 96% in gastric ulcer, 100% in duodenal ulcer, 80% in coexisting gastroduodenal ulcer, 84% in gastroduodenal ulcer with gastritis, 70% in gastritis, 100% in gastric polyps and 100% in gastric cancer, and the percentages recognized by histological studies were 81, 100, 100, 84, 71, 67, and 57%, respectively. The values in healthy controls were 55% by histological and bacteriological methods (P less than 0.001 compared with overall ulcer patients). These results supported the close association between C. pylori and gastroduodenal diseases.     

老年人上消化道出血的病因构成及相关因素研究

[目的]探讨老年人上消化道出血的病因构成及其相关因素。[方法]选取2011年2月~2013年6月间因上消化道出血到我院就诊的250例老年上消化道出血患者,对其发病原因进行统计分析,并研究病因与诱因的相关性。[结果]250例老年急性上消化道出血患者的主病因依次为：出血性胃炎（32％）、胃（24％）及十二指肠溃疡（28％）、胃肿瘤（10％）等,男性患者发病的比例明显高于女性患者（P〈O．05）;不同病因间的诱因构成不同,出血性胃炎主由酗酒（33％）引起;而胃溃疡的主诱因为饮食不当（38．1％）和长期服用药物（22％）;此外,老年上消化道出血患者中服用非甾体类抗炎药物的患者比例高达40．4％。[结论]老年患者急性上消化道出血病因主包括出血性胃炎、胃及十二指肠溃疡等,常见诱因的相关因素包括酗酒、饮食不当、药物影响等,在诊疗过程中应尽早明确病因,并针对不同病因制订不同治疗方案,才能取得患者较好的疗效及预后。     

Mucosal changes in the gastric remnant: long-term effects of bile reflux diversion and Helicobacter pylori infection

OBJECTIVE: Bile reflux is thought to be responsible for reflux gastritis and stump carcinoma occurring after partial gastrectomy for peptic ulcer. Gastritis and gastric carcinoma are also correlated with Helicobacter pylori. The aim of this study was to investigate whether diversion of enteric reflux and the presence of H. pylori infection alter long-term histological developments in the gastric remnant. METHODS: Twenty-nine patients partially gastrectomized for peptic ulcer were reoperated on with re-resection and a Roux-en-Y reconstruction because of reflux gastritis (12 patients) or severe dysplasia/early gastric cancer (17 patients). The resected specimens and subsequent biopsies from the new anastomotic region taken at endoscopies 5-17 years after reoperation were evaluated regarding the presence of H. pylori, the grade of active and non-active chronic gastritis, and the premalignant changes--atrophy, intestinal metaplasia and dysplasia. RESULTS: A progression of active chronic gastritis, atrophy, intestinal metaplasia and dysplasia was seen after re-resection and Roux-en-Y reconstruction. Non-active chronic gastritis remained unchanged. The development was, in general, independent of H. pylori infection. CONCLUSIONS: Enteric reflux may perhaps induce a histological transformation of the gastric mucosa that cannot be reversed, even if the reflux is diverted. In our study, H. pylori infection had no impact on the histological development. Factors other than enteric reflux and H. pylori infection might also be of importance.     

Location of peptic ulcers in relation to antral and fundal gastritis by chromoendoscopic follow-up examinations

The extent of fundal gastritis and the severity of antral gastritis in patients with duodenal ulcer and coexisting gastroduodenal ulcers were investigated using the endoscopic Congo red test. Forty-two patients with duodenal ulcer were followed-up by chromoendoscopy to investigate the location of gastric ulcers developed during the average observation period of 3.6 years in relation to the changes of fundal and antral gastritis. Duodenal ulcers were usually associated with extensive acid-secreting areas and moderate antral gastritis. In coexisting duodenal and antral ulcers, antral gastritis was usually severe, although fundal gastritis was of the same intensity as that seen with duodenal ulcers. In coexisting duodenal and high-lying ulcers, fundal gastritis was extensive and antral gastritis was severe. Follow-up studies showed that there was a significant relationship between the development of gastric ulcer and the changes of antral and fundal gastritis. Gastric ulcers developed in the antrum or the angulus in patients with duodenal ulcer when antral gastritis became worse, but no fundal gastritis spread. When fundal gastritis spread, ulcers developed in the gastric body. These findings suggested that development of increasing gastritis predicted the development of gastric ulceration and that the locations of gastric ulcer and duodenal ulcer were determined by the extent of fundal gastritis and the severity of antral gastritis.     

Late follow-up of gastrectomized patients for peptic ulcer: clinical, endoscopic and histopathological aspects

BACKGROUND: The gastrectomy is an uncommon procedure because the proton bomb inhibitors associated to the antibiotic outlines used to eradicate the Helicobacter pylori changed the focus of the peptic ulcer treatment. AIMS: Later evaluation on those patients who underwent partial gastrectomy as a treatment for peptic ulcer, at that time when any drug to eradicate the Helicobacter pylori was not used. The clinical evaluation included the late postoperative symptoms and postgastrectomy syndromes like dumping, diarrhea, alkaline gastritis and nutritional aspects. The upper digestive endoscopy analysed the surgery reconstruction and the gastric stump, the duodenum and the jejunum mucosa aspects. The histopathological evaluation included looking for Helicobacter pylori by using two different methods: histology and urease test. CASUISTIC AND METHODS: Fifty-nine patients, 44 (74.6%) male, median age 55.5 years old (range from 31 to 77 years old), who underwent a clinical interview and an upper digestive endoscopy. Paraffin blocks from the surgical specimen were reviewed in order to find out if the patients did have or did not have Helicobacter pylori before surgery. RESULTS: The final results show that most of the patients had very good and good clinical evolution (Visick I e II) in 96%. The most common symptoms on late postoperative are mild dyspepsia with or without Helicobacter pylori, and diarrhea, anemia and dumping occurred in, respectively, 11 (18.6%), 2 (3.4%) and 2 (3.4%) cases. The Billroth I reconstruction had the best clinical results on statistical rate. The endoscopic finding showed normal results in the most number of cases, and reflux alkaline gastritis or erosive gastritis in a few cases. Ulcer recurrences were diagnosed in two patients (3.4%), and both had positive Helicobacter pylori. Most of the patients had Helicobacter pylori (86%) before surgery and also in the postoperative time (89.9%). CONCLUSIONS: The patients had a very good clinical evolution after the gastrectomy. The Billroth I reconstruction had the best clinical results. The Helicobacter pylori is still present on gastric stump in late postoperative time, and we believe that it does not bring any negative influence to surgical results.     

Gastrointestinal Complications Following Transcatheter Arterial Embolization through Subsegmental Catheterization for Hepatic Malignancies

Abstract: We assessed gastrointestinal complications after transcatheter arterial embolization (TAE) performed over the three-year period from 1991–1994. Gastric erosion, gastroduodenal ulcer and hemorrhagic gastritis were investigated in a series of 273 cases (408 TAEs) with hepatic malignancies. Gastric erosions were found in 60 cases (7.6%), gastroduodenal ulcer in 24 cases (5.9%) and hemorrhagic gastritis in six cases (1.5%). Gastroduodenal complications occurred in a total of 60 cases (61 instances) (15.0%). Neither the formerly occurring geographic ulcers in the gastric antrum nor fatal hemorrhagic gastritis/ ulcers were encountered in the present study. This relative mildness of complications is probably attributable to superselective catheterization into the proximal hepatic artery. Such complications are due not only to ischemic changes resulting from backflow of embolic materials into the gastroduodenal artery, but also to transient liver damage caused by TAE. The incidence of complications in those taking anti-ulcer medications was 24.7% for Ha-blockers (p<0.01), 14.3% for combination therapy and 16.5% for no medication, as compared to 9.8% for PGE1 and 9.6% for Teprenone. Therefore PGE1 or Teprenone, which increase gastric mucosal blood flow, should be used to reduce the occurrence of these complications after TAE.     

Chronic gastritis and gastroduodenal ulcer: a case control study on risk of coexisting duodenal or gastric ulcer in patients with gastritis.

Chronic (atrophic) gastritis (AG) is common in active duodenal (DU) and gastric ulcer (GU) disease. In this case control study in consecutive prospective outpatients (571 cases and 1074 controls) who had undergone diagnostic upper gastrointestinal endoscopy and routine biopsies from both antral and body mucosa, we calculated the risk of coexisting active DU and/or GU in different gastritis of the antrum or body and according to grade (superficial gastritis, mild, moderate or severe atrophic gastritis). The risk of coexisting active gastroduodenal ulcer (ulcer in duodenum and/or stomach), as well as the risk of DU or GU, was dependent upon the presence and grade of gastritis in antrum and body mucosa. The risk of coexisting ulcer, as expressed as an age adjusted relative risk (RR) and calculated as odds ratio of gastritis in cases and controls, was significantly increased in the presence of superficial antral and body gastritis (RR = 8.5 (7.0-20.0) in men; RR = 5.8 (3.3-10.2) in women), as compared with the risk of ulcer in subjects with histologically normal mucosa (RR = 1). The risk of ulcer, and the risk of GU in particular, increased further with increasing severity of antral gastritis. In such patients with moderate or severe atrophic antral gastritis the RR of coexisting ulcer even exceeded 20 in men and 10 in women (RR = 25.6 (9.0-72.7) in men; RR = 11.7 (5.9-23.0) in women). On the other hand, the RR of ulcer, and the RR of DU in particular, was below 1 in the presence of atrophic gastritis in the gastric body, irrespective of the grade of gastritis in the antrum. We conclude that the type and grade of gastritis strongly predicts the risk of coexisting peptic ulcer, and that the risk of coexisting DU or GU increases with an increase in grade of AG of the antrum but decreases with an increase in grade of AG of the gastric body.     

Malnutrition after partial gastrectomy

Summary The late sequelae of partial gastrectomy in an unselected consecutive series of 109 patients included atrophic gastritis (78%), hypochlorhydria (76%), anemia (26%), low serum Vitamin B₁₂ (45%), hypoferremia (33%), hypoalbuminemia (29%), raised serum alkaline phosphatase (35%), and loss of weight (47%). The 109 cases were divided into 4 groups: duodenal ulcer with Billroth I anastomosis, duodenal ulcer with Billroth II anastomosis, gastric ulcer with Billroth I anastomosis, and gastric ulcer with Billroth II anastomosis. Statistical analysis of results in these groups showed significantly more sequelae after Billroth II gastrectomy and in patients with gastric ulcer. The gradient from duodenal ulcer with Billroth I to gastric ulcer with Billroth II was exemplified by the incidence of gastritis, 55% and 100%, anemia, 11% and 86%, low serum Vitamin B₁₂, 19% and 86%, hypoferremia, 9% and 57%, and weight loss, 28% and 86%. The incidence of gastritis rose from 2% in cases of duodenal ulcer and 32% in gastric ulcer preoperatively, to 95% and 100% respectively after Billroth II gastrectomy. Thus gastritis occurred frequently after gastrectomy, and itself may be an important determinant of the late sequelae of partial gastrectomy.Supported by a grant from the National Health and Medical Research Council of Australia.Publication No. 1152 from The Walter and Eliza Hall Institute of Medical Research.     

超细胃镜检查3844例临床分析

目的探讨超细胃镜检查的临床应用价值。方法 2004年5月至2012年5月间,应用FU-JINON公司生产的EG-470N5型上消化道超细电子胃镜（鼻胃镜）对3844例患者进行经鼻腔/口腔检查,其中常规内镜检查3786例,急诊内镜检查58例,并对72例患者进行了内镜下介入治疗及操作,包括止血、溶石术、息肉电切、异物取出、支架置入及放置螺旋型鼻肠管或辅助胶囊内镜检查。结果经鼻插镜3694例,经口150例,检出慢性胃炎2022例,消化性溃疡754例,食管炎310例,食管胃底静脉曲张、门脉高压性胃病184例,胃癌及残胃癌100例,Barrett食管64例,十二指肠球炎52例,上消化道息肉48例,残胃炎、吻合口溃疡及吻合口炎37例,食管癌29例等。因普通胃镜无法通过而经鼻胃镜检查明确诊断者16例,其中食管癌6例,胃癌4例,腐蚀性食管炎、贲门癌及球部溃疡并严重狭窄各2例。急诊内镜检查58例,54例明确诊断。镜下止血治疗29例,均获成功。活检594例次,诊断符合率94.2%。辅助螺旋型鼻肠管放置及胶囊内镜检查25例。溶石及息肉电切治疗各2例。10例因食管癌癌性狭窄患者均成功置入覆膜金属支架。成功取出嵌顿于食管的鱼刺4例。无消化道出血、穿孔等严重不良反应发生。结论超细胃镜检查痛苦小,患者易于接受,对常见上消化道疾病具有良好的诊断价值,通过超细胃镜尚可进行息肉电切、局部喷洒止血、支架置入及取出异物等内镜介入治疗,具有良好的临床应用前景。     

43例急性四氯化碳中毒性肝病患者临床及胃镜下表现

目的：观察急性四氯化碳中毒性肝病患者临床及胃镜下表现。方法回顾性分析43例急性四氯化碳中毒性肝病患者临床表现和肝功能变化情况,其中28例因显著消化道表现而行胃镜检查。结果43例急性四氯化碳中毒性肝病患者临床主要表现为乏力、恶心、呕吐和腹痛等消化道症状,伴黄疸和头晕;血清总胆红素为（16.5±13.4）μmol/L,丙氨酸氨基转移酶为（273±171）U/L,甘油三酯为（1.31±0.74）mmol/L,前白蛋白为（224±64）mg/L;28例患者胃镜下表现为轻度至重度浅表性胃炎,未见溃疡。其中糜烂明显6例,胆汁反流9例,食道霉菌5例（17.9%）。病理学检查示轻度浅表性胃炎14例,中度6例,重度8例;5例患者HP阳性,11例表现为粘膜下出血;患者平均住院时间为36天。结论急性四氯化碳中毒性肝病患者肝脏损害程度似较轻,但恢复较慢,消化道症状重,多伴有浅表性胃炎表现。